"Outcomes from Implementing a Content Validated Peristomal Skin Assessment Instrument* Within Clinical Practice"

Purpose:   Clinical knowledge and the literature suggest that peristomal skin complications usually occur in the early post operative phase. The purpose of this study was to objectively track and assess post operative patients with peristomal skin complications, and the type of skin barrier being used. Once objective data was collected, the CWOCN focus was to minimize or prevent future skin complications.

Method:  An ongoing observational study was conducted in which surgical patients with a urostomy were assessed post-operatively, and on a regular basis as determined by the patient, or other clinicians reporting peristomal skin complications. The assessment instrument was used by the CWOCNs to document the type of lesion, and location of the skin breakdown under the extended wear skin barrier. The type of skin barrier was also documented (flat, cut to fit, convex, or moldable).

Post operative urostomy patients were seen at 2-weeks post discharge, within 3 months, then as needed. By utilizing the assessment instrument, the prevalence of peristomal skin complications was identified and types of lesions categorized. In addition the type of skin barrier being used was documented.

Results:  It was noted that 38% post operative clients presented with a lesion. The majority,( 76%) within the first 3 months as a result of  using flat cut to fit skin barriers The CWOCNs decided to implement a change and discharge the clients who had flush, retracted and low profile stomas with convex moldable wafers. Printed written instructions and a visual “how to mold” guide was given to the patients and home care nurses. A follow up appointment with the outpatient CWOCN was made.  8 months after this change it was noted that only 8% have presented with lesions.